Source:

Nursing Management

Authors

The preceptor role is clinically important to the teaching and amalgamation process of the new hire into the workplace environment. Nurse preceptors are competent and expert RNs who've developed clinical knowledge and expertise over years of practice. In addition, preceptors have demonstrated a willingness to convey their knowledge to new and less experienced nurses.1 Without appropriate support and resources during the transition from new graduate to RN, the very stressful environment of soaring technology and high patient acuity can directly and negatively affect the turnover and retention of new graduates.2 Preceptors can influence the overall retention of nurses and help reduce the first-year turnover rate within an organization.2

This article will identify the potential of using a blog to increase communication between experienced and novice nurses throughout a 500-bed Midwestern health system.

Defining the problem

In the spring of 2009, a survey was conducted throughout a 350-bed hospital to a group of nurses serving in the preceptor role. The nurses were asked the location in which they worked, their years of experience on the unit, how they were selected for the preceptor role, their years of experience as a preceptor, and the education that was provided for the preceptor role.

The number of self-identified preceptors was 160 from a pool of 200 applicable RNs. Some nurses had attended a formal preceptor class in the past, but there was no identification as to how long it had been since the class and no identification of any type of follow-up. The years of experience on the units ranged from 1 to 15 years; however, most preceptors had been in the role less than 5 years.

Although there was a formal preceptor class provided three times a year, ongoing and steady follow-up wasn't consistent. There was no routine mentoring or regular support meeting for training and development of the preceptors. There were also very limited resources available to provide continuous feedback and assessment of preceptor needs and skills. In many instances, the role of preceptor was assigned to a nurse who had never received specialized training. In some cases, if the permanent preceptor wasn't available, the role was assigned at the beginning of the shift to a staff nurse who wasn't prepared to provide developmental orientation. This inconsistent and poor planning, in part, added to a 23.9% first-year voluntary turnover rating at a time when national benchmarks reflected 20.3%.3 The lack of consistency and continuity of preceptor development provided an opportunity for revamping the preceptor class.

Formulating the question

Can a blogging site increase the success of communication and preceptor orientation? A survey was sent out to the 160 self-identified preceptors to obtain input on their willingness to use the online communication tool. This survey was performed to assist with the implementation and updating of the preceptor class. The survey only generated a small response from preceptors. However, it was apparent that there was interest in creating opportunities for preceptor development and engaging them more fully.

The role of the preceptor within this organization had been perceived as inconsistent. The survey identified that continuity could provide consistency in training staff, in the ability to access available education tools for staff orientation, and in a single location for orientees to access information. Throughout the organization, the one similar and coherent strength in the planning of a preceptor site was that all hospital facilities throughout the organization employ the same intranet technology. This technology ensured that all facilities would have access to the same intranet, with the same information.

Invitations to use the intranet preceptor site were restricted to individuals who were currently in the role of self-identified preceptor. This process was guided by the information systems department to limit the numbers of unsolicited messages received by staff. There's currently no method to directly send vital preceptor information to nursing staff unless forwarded by nursing leaders. There's also an overwhelming flow of e-mail received by nurses, which is often deflected by deleting the message before reading the actual content.

One major discovery in the planning of the intranet preceptor site was that as invitations were sent out to the community hospitals, there was a lack of knowledge that the organization even had formal preceptor classes. This was identified by the e-mail responses that questioned where and how preceptor classes could be obtained. In preparing information to be provided on the site, now known as Preceptor Corner, a complete listing of classes for the year would be placed there, in addition to being posted on the education website.

Implementation

A formal invitation was sent to all self-identified preceptors, along with a list of preceptors identified by clinical educators throughout the organization. Monitoring of the blog was performed by the two education leaders to best respond to issues or concerns that would require additional follow-up or leadership decision making. The process required the blog messages to be reviewed and accepted as appropriate before being published on the site for all to view. If a message sent wasn't publishable, the concern or request would be addressed privately with the sender. This required frequent and more diligent managing of blog updates. However, a listing of all preceptors would be public so staff members could e-mail each other as desired. Preceptor Corner was set up within the organization's intranet; thus, access to the site was limited to health system employees.

Performed twice a week, maintenance of the preceptor site is necessary to ensure that messages are published and questions are answered on a routine, timely basis. Development of a vast reservoir of preceptor education in a single location provides an accessible, around-the-clock preceptor resource.

Getting it to stick

The intent was that the blog would "promote critical thinking, synthesis, and provision of information."4 The intranet preceptor site initially lacked viability in utilization by preceptor staff. Although the preceptors were invitated to visit the Preceptor Corner site for review of education information and to provide constructive feedback on the design, there was no education actually provided on the purpose and significance of the site. The lack of consistent reminders, the necessity of understanding the site, and the lack of integrating the practice of site utilization on a consistent basis helped to weaken the site's existence.

Although the return of the blog survey was reflective of only 10% of the self-identified nurse preceptors, the responses received definitely identified that the function of the intranet site could have merit within the organization. Additionally, the survey results also suggested that the best method to ensure usage of the preceptor site was to integrate it into the daily workflow.

While updating materials used within the preceptor class, an opportunity arose to introduce the online intranet preceptor site into the new preceptor class. The preceptor class was upda ted to be presented as an 8-hour seminar, which included leadership styles, an introduction to the change process, generational diversity, the role and responsibilities of the preceptor, and a special segment on the significance and implementation of Preceptor Corner. The site was presented as another resource to share between units and hospitals within the health system. At the end of the class, each preceptor received a homework assignment to access the blog and send a message with feedback on the preceptor class to the clinical education department.

It's anticipated that the success of Preceptor Corner will definitely continue to grow as acceptance of and familiarity with the site increases and as new and younger nurses take over the preceptor role. The process for accessing the site needs to be simplified, along with ensuring that all preceptors are familiar with the process of blogging. Another challenge will be the time required to manage the site.

The continuous and ongoing communication and advertisement of Preceptor Corner are opportunities to increase preceptor and preceptee use of the site. Improvement in communication with the development of intranet links can also decrease the number of steps needed to access the site and support its use. Overall, a succession plan and back-up planning need to be developed and implanted to ensure the maintenance, viability, and visibility of the site to obtain complete use of this ever-evolving resource.

Striving for consistency and quality

The information provided on Preceptor Corner has begun to filter onto multiple nursing units. Currently, the site contains information on generational diversity and American Nurses Association articles, as well as checklists and shared preceptor information from various specialty areas. The intent is to share best-practice preceptor resources throughout the organization. For each of the planned six preceptor classes for 2010, participants were required to give feedback at the end of the class via Preceptor Corner. This feedback was collected and synthesized to update future preceptor development classes, assisting in providing consistent education for new nurses and ensuring positive, quality patient outcomes.